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Immunosuppression versus Supportive Care on Kidney Outcomes in IgA Nephropathy in the Real-World Setting

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单位： [1]National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China. [2]Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. [3]Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China. [4]The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. [5]Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China. [6]Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China. [7]The Second People's Hospital of Shenzhen, Shenzhen University, Shenzhen, China. [8]Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China. [9]Children's Hospital of Fudan University, Shanghai, China. [10]Renal Department and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Center for Kidney Diseases, Chengdu, China. [11]Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China. [12]Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China. [13]Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China. [14]Huizhou Municipal Central Hospital, Sun Yat-Sen University, Huizhou, China. [15]Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China. [16]Department of Nephrology, the First People's Hospital of Foshan, Foshan, Guangdong, China. [17]Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China. [18]The Third Affiliated Hospital of Southern Medical University, Guangzhou, China. [19]Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. [20]DHC Technologies, Beijing, China.

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Background The efficacy of immunosuppression in management of IgA nephropathy remains highly controversial. The study was conducted to assess the effect of immunosuppression, compared with supportive care, in real-world setting of IgA nephropathy. Methods A cohort of 3946 patients with IgA nephropathy, including 1973 new-users of immunosuppressive agents and 1973 propensity score- matched recipients of supportive care, in a nationwide register data from Jan 2019 to May 2022 in China was analyzed. The primary outcome was a composite of 40% eGFR decrease of the baseline, kidney failure, and all-cause mortality. A Cox proportional hazards model was used to estimate the effects of immunosuppression on the composite outcomes and its components in the propensity score matched cohort. Results Among 3946 individuals (mean [SD] age 36 [10] years, mean [SD] eGFR 85 [28] mL/min/1.73m2, and mean [SD] proteinuria 1.4 [1.7] g/24h), 396 primary composite outcomes events were observed, of which 156 (8%) were in the immunosuppression group and 240 (12%) in the supportive care group. Compared with supportive care, immunosuppression treatment reduced the risk of the primary outcome events by 40% (adjusted hazard ratio 0.60; 95% CI, 0.48-0.75). Comparable effect size was observed for glucocorticoid monotherapy and mycophenolate mofetil alone. In the pre-specified subgroup analysis, the treatment effects of immunosuppression were consistent across ages, genders, levels of proteinuria, and the values of eGFR at baseline. Serious adverse events were more frequent in the immunosuppression group compared with the supportive care group. Conclusions Immunosuppressive therapy, compared with supportive care, was associated with a 40% lower risk of clinically important kidney outcomes in patients with IgA nephropathy.Copyright © 2023 by the American Society of Nephrology.

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出版当年[2022]版：

大类 | 1 区

医学

小类 | 1 区泌尿学与肾脏学

最新[2025]版：

大类 | 1 区

医学

小类 | 1 区泌尿学与肾脏学

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出版当年[2021]版：

Q1 UROLOGY & NEPHROLOGY

最新[2024]版：

Q1 UROLOGY & NEPHROLOGY

影响因子： 7.1 最新[2024版] 8.5 最新五年平均 10.624 出版当年[2021版] 10.125 出版当年五年平均 8.237 出版前一年[2020版] 9.8 出版后一年[2022版]

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第一作者单位： [1]National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

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